Basic Information
Provider Information | |||||||||
NPI: | 1457419756 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VARKALA | ||||||||
FirstName: | SREELATHA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5400 PINEHURST DR | ||||||||
Address2: |   | ||||||||
City: | SPRING HILL | ||||||||
State: | FL | ||||||||
PostalCode: | 346063833 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3522775348 | ||||||||
FaxNumber: | 3526062857 | ||||||||
Practice Location | |||||||||
Address1: | 36542 SR 54 | ||||||||
Address2: |   | ||||||||
City: | ZEPHYRHILLS | ||||||||
State: | FL | ||||||||
PostalCode: | 335416938 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3522775462 | ||||||||
FaxNumber: | 3526160912 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/05/2006 | ||||||||
LastUpdateDate: | 10/04/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/04/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME955528 | FL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RN0300X | ME95844 | FL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
ID | Type | State | Issuer | Description | 2878590 | 01 | GA | UHC | OTHER | 6010045 | 01 | GA | CIGNA | OTHER | 52230371 | 01 | GA | BCBS | OTHER | 01167457 | 01 | GA | AMERIGROUP | OTHER | 480753783A | 05 | GA |   | MEDICAID | 9180089 | 01 | GA | AETNA | OTHER |